Journal article
DASC-LOT Framework and S3 Metric: A Novel Evaluation and Benchmarking Method to Assess Initiation, Duration, and Spectrum of Antimicrobial Usage at Inpatient Hospital Settings
Clinical infectious diseases
06/25/2026
DOI: 10.1093/cid/ciag389
PMID: 42345285
Appears in UI Libraries Support Open Access
Abstract
Inpatient antimicrobial stewardship programs (ASPs) promote avoiding unnecessary initiation, excessively long duration, and overly broad-spectrum selection of antimicrobials, but currently available metrics do not adequately reflect or distinguish these three components. We aimed to develop a novel framework that captures them while providing information specific to each, based on Days of Antimicrobial Spectrum Coverage (DASC) and length of therapy (LOT).
We developed a three-level conditional modeling framework to extract hospital-level variability, risk-adjusted for three components (initiation, duration, and spectrum). This was applied to data from 118 Veterans Health Administration (VHA) hospitals, with models built on 2022-2023 data and validated with 2024 data. Patient demographics, intensive care status, admitting specialty, 86 comorbidities, and 224 procedure categories were considered candidate variables for risk adjustment. Overall hospital performance was evaluated using a composite metric that integrated three components ("S3 [start, stop, select] Metric") and was visualized in a radar chart for each hospital.
The cohort included 727,958 unique patients with 9,363,922 days present. Hospital-level usage ranged widely (DASC per 1,000 DP: 1,311-5,275 [interquartile range (IQR): 2,738-3,563]; LOT per 1,000 DP: 132.2-517.6 [IQR: 301.0-367.5]). Risk-adjustment models included 116 variables for initiation, 77 for duration, and 91 for spectrum components. S3 metrics ranged from 0.703 to 1.572 (IQR: 0.906-1.086). A three-component evaluation could provide specific information on each hospital's usage patterns.
We propose a DASC-LOT framework and S3 metric to assess ASP practices in initiation, duration, and spectrum separately while providing overall composite benchmarking.
Details
- Title: Subtitle
- DASC-LOT Framework and S3 Metric: A Novel Evaluation and Benchmarking Method to Assess Initiation, Duration, and Spectrum of Antimicrobial Usage at Inpatient Hospital Settings
- Creators
- Michihiko Goto - University of IowaShungo Imai - University of IowaHyunkeun Cho - Human Longevity (United States)James A Merchant - Iowa City VA Health Care SystemMatthew Bidwell Goetz - University of California, Los AngelesEli N Perencevich - University of IowaBruce Alexander - Iowa City VA Health Care SystemQianyi Shi - University of IowaAndrea Holcombe - University of IowaDaniel J Livorsi - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases
- DOI
- 10.1093/cid/ciag389
- PMID
- 42345285
- NLM abbreviation
- Clin Infect Dis
- ISSN
- 1537-6591
- eISSN
- 1537-6591
- Publisher
- Oxford University Press; CARY
- Grant note
- US Department of Veterans Affairs (VA) through a quality improvement initiative of VA Midwest Health Care Network: VISN 23 VA Office of Research Development: HX003595 Center for Access & Delivery Research and Evaluation (CADRE) in the Iowa City VA Health Care System: CIN-13-412
This work was supported by the US Department of Veterans Affairs (VA) through a quality improvement initiative of VA Midwest Health Care Network (VISN 23) and a research grant from VA Office of Research & Development (HX003595: Co-PIs: Livorsi/Goto). This work is also supported by resources and facilities at the Center for Access & Delivery Research and Evaluation (CADRE; CIN-13-412) in the Iowa City VA Health Care System. The funding sources had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.
- Language
- English
- Electronic publication date
- 06/25/2026
- Academic Unit
- Neurology; Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9985176657402771
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